Infectious Dz and Allergies/Immunology Flashcards Preview

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Flashcards in Infectious Dz and Allergies/Immunology Deck (103):
1

Things that can affect your dx with infectious disease

Season
Age
General health
Fever
Previous sx
Exposure
Travel
Daycare
Immunization therapy

2

Work up for infectious dz- general

CBC
-Left shift in CBC means high neutrophils can include bands
-Right shift is high lymphoctes
Gram stain
Cultures
LP
Rapid screening test
PCR (DNA, RNA)
Imaging

3

DDx- viral- ID

Petechiae
Neutropenia
Lymphocytosis

4

DDx- bacterial- ID

Petechiae
Purpura
Leukocytosis- left shift
Neutropenia
Increased ESR/CRP

5

What does secondary prophylaxis include?

Meningococcus
Tetanus
-Dirty wound, give if they have not had shot within 5 yrs
-Clean wound, give if they have not had the shot within 10 yrs
Rabies
-Immunoglobulin, inject into wound as much as you can, then give IM injection
-Day 1, 3, 7, 14 for vaccine schedule
-Try to find the animal
-Document if they decline

6

Fever without source: 1-3 mos

Viral
Bacteremia
-GBS
-E. coli
-Listeria monocytogenes
UTI
-E. coli
Pneumonia
-S. pneumoniae
-S. aureus
Meningitis
-S. pneumoniae
-HSV
-Enterovirus
-N. meningitidis
Bacterial diarrhea
-E. coli
-Salmonella
-Shigella

7

Fever without source: 3 mos- 3 yrs

Viral
Occult bacteremia
- Greater than or equal to 102.2
-WBC > 15K
-Left shift
-Increased ESR/CRP
UTI
-UA, URC, BLDC

8

What to do with < 3 mos with fever?

Usually do an LP
Neonate: run your basic tests: BCx, CBC, CXR, urine

9

You don't usually see strep in _____

< 2 yo
Will see URI, OM

10

Fevers of unknown origin

Infections
Inflammatory dz
-15%
Malignancy
-10%
Fictitious

11

Fever and rash in peds

Macular/maculopapular
-Usually measles or rubella
Diffuse erythroderma
Urticarial
Vesicular, bullous, pustular
Petichial-purpuric
Erythema nodosum

12

Characteristics of measles

Papular lesions of trunk, neck, face
Red watery eyes
Grey-white spots in the mouth

13

Characteristics of rubella

Typically lasts around 3 days
Body aches
Anorexia
HA
Pharyngitis
Conjunctivitis
Low-grade fever
Highly contagious, but resolves on its own

14

Characteristics of roseola infantum

HSV 6 and 7
Abrupt fever, rose-colored maculopapular rash lasting 3-5 days
Cough

15

5ths dz- characteristics

"Slapped cheek"
Caused by parvovirus B19
Usually occurs during springtime
Diagnose with PCr
Reoccurs with bathing, rubbing
Mild anemia, lymphopenia

16

Tx for herpes zoster

Antivirals and pain meds
Give hydrocodone at hospital but not for the 4 wks that you'll treat it

17

Varicella zoster

Do not give ASA or acyclovir
Could develop post-secondary staph and strep infections with scratching and dirty fingernails
Give the vaccine at 12-15 mos and 4-6 yrs
-85% effective in preventing dz
-95% effective in reducing severity

18

Impetigo characteristics

Bolus impetigo has clear fluid-filled cysts
Crusting, yellow, honey-crusted
See on Gram stain: purple (Gram pos) cocci in clusters
Give 2% mupirocin

19

Cellulitis

Demarcate with a pen, tell them to come back in 24 hrs to the ER
Look for LAD, check above and below
Is there any fluctuation in the wound? Do you want to I and D?
Shot of Rocephin, then diclocycillin or Keflex

20

Erysipelas

Just dermal area, not full thickness
Line of demarcation is very clear
Causative agent is group A strep
If IC or DM, try to convince hospitalist to admit

21

Forunier's gangrene

Caused by staph, strep, clostridium
Very quick progression
Need immediate surgical consult
IV clinda, surgeon may add aminoglycoside, may also use Rocephin

22

Folliculitis

Affects follicles of hair cells
Pseudomonas, staph are causes
Chlorhexidine 1% or clinda cream

23

Ringworm

Use KOH prep to diagnose
Will see budding, septate or aseptate hyphae
Treat with miconazole, clotrimazole
Takes time to heal
Use a thin layer, and keep it dry

24

Herpetic whitlow

Pruritis and pustules
Valacyclovir

25

Herpes gladitorium

Worry about eyesight
Do a slit lamp exam and document when it doesn't affect the eye
Otherwise, you need to call an ophthalmologist

26

HPV vaccine

Give between ages 9-26
Quadrivalent covers 6, 11, 16, 18
3 doses
98-100% effective

27

Molluscum contagiosum

Cause is pox virus
Fleshy, skin-colored lesion with dimple
Self-limiting over several mos

28

What can be seen on a blood smear with mono?

Atypical lymphocytes

29

Cat scratch or bite

Could affect epitrochlear LN
Boggy
Caused by Pasturella multocida
Give Augmentin

30

M. Kansaii

Usually a post-surgical infection
Can also involve soft tissue
Found in TX, LA, FL, KS, IL
Treat with rifampin, methambutol

31

Encephalitis types

California
St. Louis
Equine
West Nile
-Occurs in summer in North America
-Sore throat, fever, aching, lethargy, HA, behavior changes, neuro deficits

32

Encephalitis work up

Get a CSF test
-Viral: nl glucose, slightly elevated protein
-Bacterial: low glucose, high protein
LP
BCx
CBC
MRI

33

Mechanism of encephalitis

Infection
Immune-mediated response
Herpes is MCC of sporadic encephalitis in children

34

Colds

Antihistamines and decongestants are not recommended for children under 6 yrs
If no better in 10-14 days consider bacterial

35

Sinusitis

Get a water's view CT
-Will show areas of exudate, inflammation, or possible Netty pot use
Causes are M. catarrhalis, H. flu, S. pneumoniae
With children, look for a FB
Look for fever, tenderness mucopurulent d/c in nare
Treat with Augmentin

36

Otitis media

If it's happened too many times, refer to ENT for possible myringotomy

37

Difficult cases of otitis externa

If canal is really tight, use an earwick
Put liquid lidocaine on there before inserting it

38

Croup

Steeple sign on X-ray
Usually in fall and winter mos
Give dexamethasone
Consider racemic epi to reduce subglottic edema

39

Epiglottitis

See thumb print sign on X-ray
Hib, staph, strep are causes
Treat with tube, abx

40

Pertussis

B. pertussis
Spread by cough
Stages
-Catarrhal
-Paroxysms
-Convalescent
Peak incidence < 4 mos
Typically seen in 1-10 yos
Contagious for first few weeks
Runny nose, low-grade fever
WBC 20K
Lymphocytosis of 75-80%
Give azithromycin, clarithromycin

41

Bronchiolitis

Affects small bronchioles
Late fall to early spring
Runny nose, low-grade fever, cough
Leading cause of hospitalization in infants
ELISA to diagnose
Primarily caused by RSV
Hyperresonance on percussion with diffuse wheezes or crackles

42

PNA

Bacterial PNA is typically lobular
Not getting better, do another test, like a CT
Increased interstitial marking like tree branches indicates a viral infection
Treat with Z pack for CAP
Induce a sputum culture with a neb

43

Types of pneumonia

Atypical
Bronchial
SARS
-Coronavirus
PNA in the IC
-Gram neg enteric bacteria
-Virus
-Fungi
-Mycobacteria

44

PNA workup

CBC
-Bacterial vs viral
-Sputum gram stain and culture depending on child's age
-Rapid viral antigen detection
PCR
Blood cultures
CXR

45

DDx of PNA

CF
AIDS
Disorders of leukocytes
Disorders of cilia
-Kartagener syndrome- immotile cilia
GERD
FB

46

Complications of PNA

Abscess secondary to lung necrosis
Empyema
Effusion
Bronchiectasis d/t scarring
Penumatociles- thin blebs, air or fluid-filled, can sometimes pop
Bronchiolitis obliterans
-small airways are replaced scar tissue
Sawyer-James syndrome
-Severe necrotizing pneumonia
-Increased translucency of lung
-Adenovirus type 21

47

Tx of PNA

Do culture and MIC
S. pneumoniae MIC < 2- Ampicillin/PCN/amoxicillin
S. pneumoniae MIC >4- Ceftriaxone/Levoquin/Linezolid
Mycoplasma- Zithromycin
MRSA- Clindamycin or Vanc IV
HSV- acyclovir

48

Infective endocarditis

Reasons for kids to get this- wound that hasn't healed well or very infected, dental work
Bacteria
-Viridians step
-S. aureus
-Hemolytic strep A, B, C, G, D
-Cause vegetation on valves, which become incompetent. Results in hemolyzing blood
Fungi
-Candida

49

Workup for infective endocarditis

ESR/CRP
CBC
BLDC
RF/ANA- may be positive
Echo- consider doing TEE instead of transthoracic- more sensitive

50

Complications of infective endocarditis

Emboli
Abscess
Aneurysm

51

Tx for infective endocarditis

Viridians strep- PCN G 4 wks
May consider Pen G plus aminoglycoside 2 wks
Surgery
Cure rate >90% in uncomplicated endocarditis d/t viridians

52

Acute gastroenteritis

Diarrhea
Leading cause of morbidity and common in US
Person-to-person contact
Contaminated food/water
If you see both nausea and vomiting at the same time, consider food poisoning

53

Acute gastroenteritis bacteria

E. coli
Salmonella
Shigella
Vibrio cholera
B. cereus- refried rice
S. aureus- mayo

54

Acute gastroenteritis virus

Rotavirus
Adenovirus 40 and 41
Norovirus

55

Acute gastroenteritis parasites

E. histolytica
Giardia lamblia

56

Labs for acute gastroenteritis

BMP- worried about dehydration, look at electrolytes
Sodium may be low
CBC
Fecal culture
Ova and parasites

57

Tx of acute gastroenteritis

Bacterial: 3rd gen cephalosporin S. typhi
Parasite: Metronidazole
Virus: supportive

58

Hepatitis

Types A, B, C, D, E, G
A= poor hand washing
B+ D= chronic hep
-Could lead to fulminant hep, cirrhosis and CA
HBV and HCV
-IV drugs, maternal fetal, blood products/needle stick

59

Tx of hepatitis

HBV
-Interferon Alpha-2B or lamivudine
HCV
-Interferon or in combination with ribavirin
Most cases of acute viral hep resolve in time
-HAV and HEV- acute
-HBV, HCV, HDV= chronic, possible cirrhosis and carcinoma

60

UTI labs

Ensure clean catch
UA
URC
Imaging if necessary
-Could have stone or chronic kidney or bladder infections due to vesicourethral reflux
Chlamydia culture if suspect

61

UTI possible origin in teens

Staph saprophyticus, chlamydia and E. coli 12-72 hours after intercourse
Causes urethral syndrome and urethritis

62

Vulvovaginitis

MC gyn in children

63

Causes of vulvovaginitis

Physiological leukorrhea- nl
Non-specific: nl
Bacterial
-3 criteria: homogenous d/c, pH >4.5, a little fishy odor
-Also see clue cells
-Treat with metronidazole
Candidiasis
-Treat with metronidazole
Enterobiasis- pinworms
-Treat with mebendazole
Giardiasis
-Treat with metronidazole
Molluscum contagiosum
-Treat with curretage
Phthirius pubis: crabs
-Treat with permethrin
Scabies
-Treat with permethrin
Staph/strep
-Treat with dicloxacillin or 1st gen cephalosporin
FB

64

UTI parenteral tx

Cephtriaxone or gentamycin

65

UTI oral tx

Cephalosporin
Augmentin
Septra/Bactrim

66

chlamydia

70% of women are asymptomatic
Gram neg
May lead to PID
-Abd pain
-Adnexal tenderness
-Pain on cervical motion
-Fever
Tx
-Rocephin + doxy or Azithro

67

Syphilis

Treponema pallidum
Great imitator
Primary-chancre
Secondary- fever, LAD, rash, condolomata lata lesion
Tertiary- organ damage, neurosyphilis, aorta
Diagnose with dark field microscopy

68

Tx of syphilis

Primary- 2.4 mil U pen G benzathine q2-4h x 10 days
Secondary: 2.4 mil u pen G x 3 wks (3 doses)
Tertiary: 3-4 mil U pen G q4h x 10-14 days

69

HSV

Pre-herpatic pain
Vesicular
HSV culture
Rx
-Acyclovir/Famcivlovir/Valacyclovir
Post-herpatic pain lasts 3-4 wks
Meds reduce recurrence by 75%

70

H. ducreyi

Bacterial
See chancre
Culture
Tx: Azithro 1 gm po

71

Granuloma inguinale

Cause is Klebsiella
Requires bx for staining
Tx: Doxy

72

Trichomoniasis

Vulvular inflammation
70% asymptomatic
D/c- frothy bubbly
Strawberry cervix
Diagnose with KOH
Tx: metronidazole

73

Candidiasis

Thick d/c with itch
Candida albicans
Consider DM/BCP/ current or recent abx
KOH
Fluconazole or nystatin for tx

74

Genital warts

HPV aka condylomata acuminata
Firm grey to pink
Cervical neoplasia or dysplasia
HPV 16 and 18 (70% cancer)
Tx: Podofilox or cryo

75

Type I allergy

Immediate
IgE
Anaphylaxis, angioedema, urticaria

76

Type II allergy

Cytotoxic
IgM, IgG, complement, phagocytosis
Cytopenia, nephritis

77

Type III allergy

Immune complex
IgM, IgG, complement, precipitins
Serum sickness, vasculitis

78

Type IV allergy

Delayed
T-lymphocytes
Contact dermatitis

79

Idiopathic allergy

Effector mechanism varies
Non-specific rash

80

Dx of allergies

Skin patch testing
RAST (radioallergosorbent test) panels
CXR
CT sinuses
Serum immunoglobulins

81

Allergic rhinitis

Eosinophilic inflammation of nasal mucosa
PE will show a transverse nasal crease
Eosinophils will be present in nasal secretions and elevated on CBC
Non-allergic rhinitis is more likely vasomotor, infectious, or secondary to a FB

82

Allergic rhinitis medications

Mild: antihistamines PRN
Moderate: routine administrations of LTRA (Leukotriene receptor antagonist)- Singulair (montelukast)
Severe: topical nasal steroid, immunotherapy, antihistamine, or LTRA

83

Systemic anaphylaxis

Rapid onset allergic reaction d/t the widespread degranulation of mast cells after crosslinking of IgE on the mast cell surface
Often secondary to bee stings, food exposures, or drug administration
Severe manifestations: airway obstruction, hypotension

84

Stings

Good to watch if you have FHx
Tx: Children younger than 16 with diffuse urticaria require epi
Children >16 are treated as adults and require subQ epi
Any child with a systemic rxn to a bee sting requires referral to an allergist
Any child with a life-threatening rxn to a bee sting requires venom immunotherapy which is 98% effective in preventing future rxns

85

Anaphylaxis therapy

Epi is primary
Antihistamines are secondary
For severe event steroids may prevent late-phase rxn

86

Angioedema

Hereditary angioedema: autosomal dominant d/o characterized by the absence or abnormal function of the C1 esterase inhibitor which results in increased vascular permeability
Angioedema related to allergic rxn: self-limiting, episodic, commonly triggered by minor trauma
Give benadryl, dexamethasone

87

Asthma causes

Allergens
-Pollen, mites, animal dander, mold
Irritants
-Tobacco smoke
Viral infections
-RSV
-URI
Exercise

88

Allergy meds

Antihistamines
-1st gen: sedation problems
-2nd gen: preferred where sedation a problem
LTRA
-Similar efficacy to antihistamines
Mast cell stabilizers
Topical corticosteroids
-Most effective, block more aspects of allergic inflammatory response

89

Allergic conjunctivitis

If bacterial, will have matted eyes, exudative drainage, whereas allergic has clear fluid
Acute or chronic, seasonal and perennial
Itching and excessive tearing
Tx is with saline eye drops and antihistamines

90

Causes of a cough in a child <1

CF
Resp tract infection
Aspiration
Dyskinetic cilia
Lung/airway malformation
Edema

91

Long-term controlled meds for asthma

ICS
LTRAs
-Zafrilukast > 5 yrs BID
-Montelukast QD
--6 mos-5 yrs 4 mg
--6-14 yrs 5 mg
--15 yrs and above 10 mg

92

LABA

Relax airway smooth muscle
No anti-inflammatory
BID
>5 yrs
Maintenance
Prevention of exercise-induced asthma

93

Omalizumab (Xolair)

Anti-IgE AB
Mod to severe asthma
12 yrs and older
SubQ q2-4 wks

94

SABA

Bronchodilator
Acts in 5-10 mins
4-6 hr duration
Prophylaxis

95

Ipratropium

Relieves bronchoconstriction
Decreases mucus hypersecretion
Reduces cough
Not for long-term use

96

Corticosteroids

Acute exacerbation
3-10 days
1-2 mg/kg/day then 1 mg/kg/day days 2-5

97

General tx principles in asthma

Step up-step down therapy
All children should have short acting MDI
ICS preferred for all children-persistent asthma
Rules of two;
-Sx 2 or more days/week
-Sx 2 or more nights/mo

98

Primary immunodeficiency

Refers to a group of more than 300 rare, chronic disorders in which the immune system fails toa ct appropriately
Red flags:
-Severe infections requiring hospitalizations at an early age
-Persistent or recurrent illnesses
-Infections secondary to obscure or uncommon organisms

99

Things to check with immunodeficiency

CBC to look for neutropenia or lymphopenia (SCID), esosinophils (allergic dz) or anemia (chronic dz)
Serum immunoglobulin levels should be obtained: IgG, IgA, IgM, IgE, IgD

100

DiGeorge syndrome

Partial immune defects with low T-cell numbers and functions that tend to improve with age
Known as velocardiofacial syndrome or catch 22 syndrome because of the Cardiac anomalies, Abnormal facial features, Thymic hypoplasia, Cleft palate and Hypocalcemia stemming from deletions in chromosome 22q11.2

101

Wiskott-Aldrich syndrome

X-linked disorder that results from defects in both cell-mediated and humoral immunity. There is a predisposition of lymphoproliferative disorders
Children presents with the triad of thrombocytopenia (low platelets), eczema and recurrent infections

102

Chediak-Higashi syndrome

Abnormality of secondary granule that results in defective neutrophil and NK cell function
Usually presents with partial oculocutaneous albinism
Most cases progress to a lymphoproliferative syndrome with generalized fever, jaundice, hepatomegaly and pancytopenia

103

Stem cell therapy

This is the only cure available for primary immunodeficiency
Stem cells are found in bone marrow, cord blood and peripheral blood
The main risk associated with stem cell therapy is GVHD